The Trump administration is rolling back provisions that make family planning services affordable and accessible. This is a mistake. It will damage prospects for women, children, and the economy. Far from cutting back these services, we should be expanding them.
Improved access to the most effective forms of contraception has empowered millions of women to control their fertility and, with it, their economic fortunes. Multiple studies have attributed gains in women’s educational attainment and employment to increased access to contraception. Women’s greater workforce participation has fueled economic growth since the 1970s, but female participation rates in the U.S. are now declining. Reversing these recent trends and growing the economy requires building on the incredible progress made on contraceptive access, not rolling back these advances.
And while some states have moved to make contraception more widely available, family planning funding cuts in other states and rollbacks at the national level are jeopardizing all of the progress that has already been made for women, children, and the economy at large
progression on teen birth rates, thanks to contraception
Efforts to increase women’s economic empowerment through improved contraceptive access are not shots in the dark. We know that unintended childbearing is bad for both parents and children, and that almost all unintended pregnancies result either from the failure to use any kind of birth control or from inconsistent and incorrect use. But progress is possible. Just look at the dramatic decline in the teen birth rate in recent decades. In 2016, it was under one-quarter what it was in 1960.
While causation is notoriously tricky to tease out, experts agree that this is largely thanks to the improved use of the most effective forms of contraception. The use of LARCs among teens seeking contraceptive services at Title X family planning clinics increased from 0.4 to 7.1 percent between 2005 and 2013.
And contrary to the fear among many that contraceptive coverage could “affect risky sexual behavior in a negative way,” expanded access to contraception has not coincided with an increase in risky sexual behavior among teens. In fact, the share of teens who are sexually active has declined since 1991.
Contraceptive costs matter
While teen birth rates have plummeted, other groups have not witnessed similar progress. Almost half of all pregnancies in the U.S are still unintended. The rate of unintended pregnancy has declined for all women, but much less so for poor and minority women.
Why these disparities? For one, birth control is expensive. Without insurance coverage, costs range from $20 to $90 per month for oral contraceptives and up to $1,000 for an IUD. Over an entire year, this represents 1.5 to 7 percent of the income of a full-time minimum wage worker – it’s not pocket change.
And when the price is high, it has a notable effect on birth rates. A sharp and unexpected price increase for oral contraceptives in Chile was followed by a rise in the rate of unintended pregnancy and a 4 percent increase in the weekly birth rate, driven by children born to unmarried mothers, mothers in their early twenties, and first-time mothers.
But when the price is low, more women are able to use contraception to control their fertility. When the ACA eliminated cost sharing for birth control, more women were able to access prescription contraceptives and choose effective long-term methods. Results from the Colorado Family Planning initiative (CFPI), a $23 million program focused on improving LARC access at Title X clinics, showed that counties receiving funding witnessed an additional 6.4 percent decline in teen birth rates relative to comparable U.S. counties with Title X clinics—with larger effects in high-poverty counties. Seventy percent of participants in the contraceptive CHOICE Project chose a LARC when educated about the benefits and provided their choice of contraception at no cost.
These programs have shown that reducing the cost of contraception can have substantial positive impacts. Some states have sought to restrict funding for family planning services, making contraception more expensive or out of reach for certain populations. In Texas, $73 million in funding cuts to family planning services led many facilities to close and the costs for services to increase. Many studies have shown that these funding cuts increased birth rates in affected counties, particularly among young, low-income, and unmarried women, precisely the groups most at risk of being poor and needing government assistance. If we want to reduce unplanned pregnancies, the abortion rate, single parenthood, and government spending, these funding cuts are entirely misguided. Every dollar spent on family planning saves about $7 in spending for Medicaid, welfare, and other social services.
Expanding (not retracting) access improves lives and boosts economic growth
The many advances in contraception effectiveness and access have enabled millions of women to further their educations, compete in the workforce, and control their futures. And while teen birth rates have plummeted in large part thanks to these advances, other groups have yet to experience comparable progress. Building upon the progress that has already been made means ensuring that more women have access to effective forms of contraception and, likewise, more control over their fertility. Rolling back these advances is not just bad for women and their children, it is bad for the economy. If the administration is serious about targeting high GDP growth, helping women align their behavior with their intentions would be a good place to start.